I was leading a half-day workshop for new healthcare managers at a practice group in the Midwest recently, when one of the participants, Marilyn, shared her frustration with how an underperforming direct report, Sue, was responding to feedback.
“Every time I address these issues with her,” Marilyn said, “Sue responds with deep anguish. She tells me how awful she feels, acknowledging that she knows she’s letting everyone down. She’s remorseful and apologetic, almost to the point of making herself a martyr. Then she goes out and…nothing changes..”
Despite multiple feedback conversations with Marilyn, Sue continues to show up late, not complete all of her responsibilities, and make errors along the way.
“She seems to genuinely feel badly, but I’m pretty fed up at this point,” Marilyn told me.
“Then it’s time,” I told her, “to stop discussing incidents and start discussing the pattern.”
Marilyn is having the same conversation over and over again and not getting results. Sue’s performance hasn’t changed…because she hasn’t made such change a priority or perhaps she is not capable of making the changes Marilyn is asking for. In either case, Marilyn isn’t holding Sue accountable.
Marilyn needs to have a direct conversation with Sue to A) acknowledge this pattern, B) outline legitimate consequences, and C) have Sue take responsibility for what happens next. Here’s how that conversation might start:
“Sue, we’ve had several conversations about being on time and getting everything done, but nothing has changed. This is a pattern I am concerned about and one that can’t continue. What are your thoughts?”
While Sue may want to debate the details of prior incidents, or defend her efforts to change to this point, it’s incumbent upon Marilyn to keep the dialogue focused on the larger pattern at hand. That might sound something like this:
“Sue, we’ve discussed those specifics before. My concern today is about a bigger issue: the pattern of us having a conversation, you insisting it won’t happen again, and then it does. At this point, what would you do if you were me?”
It’s imperative that Marilyn asks Sue what should happen if Sue’s problematic performance shows itself again. If Sue responds by asking for another warning or reminder, Marilyn can make it clear that that’s not an option. Like this:
“We’ve already had several conversations about this, so that’s not a step that makes sense to take again. So, with that in mind, what should occur if this happens again?”
Sue needs to understand the specific, legitimate consequences that will ensue if the behavior reoccurs. If she does not identify reasonable consequences in response to Marilyn’s question above, Marilyn has to outline specifically what happens next if Sue relapses. That may be the next step in your organization’s corrective action process. This may also sound like a “Now or Never” conversation. “Now or Never” conversations pointedly indicate that the employee’s future is in jeopardy, and may unfold as follows:
“Sue, we seem to be stuck and we’re running out of options. This is the moment where things must change. I still think there’s a chance you can be successful in this role, but if things don’t change immediately, this is what will push you out. I want to see you succeed, and believe you can. Tell me how to help you.”
The “Now or Never” conversation is neither confrontational or dictatorial. It’s delivered with kindness and empathy.
As I shared these strategies with Marilyn in our workshop and coached her through some varying responses, she returned briefly to Sue’s penchant for gratuitous apology. “I know what she’ll say. She’ll just go on and on about how bad of an employee she is and how awful she feels. I’ve just grown tired of hearing it and don’t know what to say.”
“She may genuinely feel remorse, but it’s also likely she’s learned to use that behavior as a defense mechanism,” I said. “I bet you end up responding by consoling her or rejecting her over-the-top critique of herself.”
“Exactly!” cried Marilyn.
“That has to stop.” I told her. “I’ll give you a single sentence that can quickly disrupt that routine.”
“What is it?” Marilyn asked.
“I don’t believe you.”
“Oooooooo…,” remarked several in the room.
“Do you believe her?” I asked Marilyn.
“Not really,” she said.
“Why not?” I asked.
“Well…,” Marilyn said as she gathered her thoughts, “Because if she really did feel badly, she would do something about it…”
“Whether Sue’s remorse is genuine or not, she probably needs to be challenged by you to disrupt this apology routine,” I suggested. I advised Marilyn that the next time Sue starts her repentance reaction, say matter-of-factly, without condescension or disdain:
“Sue, I don’t believe you. [Pause] Because if it were true, these things wouldn’t keep happening.'”
Marilyn left the workshop feeling energized and prepared for future conversations with Sue. Before we finished, I told her what I tell other practice managers and healthcare leaders when doing training programs on “soft skills” like giving feedback, coaching employees, and managing performance: “Feedback isn’t just a skill. It is also a philosophy. The best leaders care enough about people to tell them the truth, even when it’s uncomfortable.”
Marilyn’s strategy is clear: disrupt the pattern, layout legitimate consequences, and shift the responsibility for change back to the employee. At this point, if the change doesn’t occur, Marilyn can take more significant action that will come as no surprise to the employee.
Joe Mull, M.Ed is a speaker, author, and trainer who teaches healthcare leaders how to be better bosses. His book Cure for the Common Leader: What Physicians & Managers Must Do to Engage & Inspire Healthcare Teams can be found here. To get his regular “Help for Healthcare Leaders” email newsletter, visit www.allytraining.com.